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What alternatives to surgery are there for Urethral syndrome?

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Q-I have been diagnosed as having urethral syndrome. My consultant has been unable to offer me any choice of treatment, except a stretching of the urethra. He was unhelpful when I asked for more information about this operation, and he became angry when I said that I had read that this operation may have harmful side effects, and may not be a useful operation in any case. I am nervous about having an operation that may be harmful. WT, Manchester.........

A-Urethral syndrome is a broad term that covers a range of diseases of the urinary tract and bladder. It's even been called the 'female prostate'. The condition is very common, and it's been reckoned that 20 per cent of the female adult population will see their GP at some time with the problem.

Not surprisingly, the syndrome can be triggered by a variety of causes. Often, it is caused by infection sometimes sexually transmitted but this is by no means the whole story: trauma, allergies, age and the onset of the menopause, stress and even muscular abnormalities have all been suspected.

There's even a small pocket of resistance that regards urethral syndrome as a myth, no doubt the creation of hysterical women seeking attention whereas a similar condition in men is usually referred to as "painful"!

One study found that 80 per cent of all cases are caused by Escherichia coli infection, while fertile women may also be infected by Staphylococcus saprophyticus (Tidsskr No Laegeforen, 1991; 111: 215-8). The most common infection in a study of 237 patients was with Ureaplasma urealyticum, found in 38 per cent of the group. Sexual infections such as herpes and gonorrhoea were also found in a small percentage (Int J Gynaecol Obstet, 1988; 27: 177-80). The bacteria Chlamydia trachomatis is also frequently linked to the condition (Salud Publica Mex, 1992; 34: 301-7).

The standard treatment is a course of antibiotics. In a study of 77 patients, 75 per cent reported improvement with wide spectrum antibiotics, including macrolides and mepartricin (an antifungal and antiprotozoal) (Eur Urol, 1994; 26: 115-9). A three month course of nifedipine, a calcium inhibitor, was also effective (Urol Clin North Am, 1994; 21: 107-11).

Surgery, and in particular urethral dilation, came to the fore 20 years ago, and is based on the theory that the syndrome is caused by anatomical problems (Minn Med, 1990; 73: 33-4). It is an approach that has fallen out of favour among urologists who left medical school less than 10 years ago. A questionnaire among 194 urologists in the US found that 60 per cent of those trained in recent years would never consider dilation as an option. Interestingly, 21 per cent trained more than 10 years ago thought dilation was "very or extremely successful" in treating the syndrome whereas none of the group trained more recently shared that view (Urology, 1999; 54: 37-43).

Of all the alternative treatments, acupuncture helped to improve the condition in 128 patients better than standard Western treatment given to 52 other sufferers (J Trad Chin Med, 1998; 18: 122-7).